Provider Demographics
NPI:1912489964
Name:KUZNAR PSYCHOLOGY FOR WELLNESS AND WELL-BEING, LLC
Entity Type:Organization
Organization Name:KUZNAR PSYCHOLOGY FOR WELLNESS AND WELL-BEING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:KUZNAR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NT
Authorized Official - Phone:248-259-2382
Mailing Address - Street 1:37095 DICKINSON CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-4818
Mailing Address - Country:US
Mailing Address - Phone:248-259-2382
Mailing Address - Fax:
Practice Address - Street 1:18600 NORTHVILLE RD STE 400C
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-3544
Practice Address - Country:US
Practice Address - Phone:248-243-4386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015602101YP2500X
MIPF0000000882476101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1649720111Medicaid